Assessment of malingering with repeat forensic evaluations: patient variability and possible misclassification on the SIRS and other feigning measures.

Résumé

Patients with Axis I disorders often fluctuate markedly in their clinical presentations in forensic and other professional settings. Although such fluctuations could suggest ineffectual efforts at malingering, more likely explanations include confusion or poor insight into psychopathology, imprecision in the assessment methods, or actual changes in symptomatology. An important concern is whether such fluctuations, common in repeat forensic evaluations, might lead to false-positive results-specifically, the misclassifications of patients as malingerers. We used the Structured Interview of Reported Symptoms (SIRS) to examine the effects of repeat administration of the interview on 52 likely genuine forensic inpatients. As expected, test-retest correlations for individual SIRS scales were highly variable. Despite this variability, the magnitude of differences remained small. The SIRS produced no errors in the classification of likely genuine forensic inpatients at the first or the repeat administrations. Implications of variable clinical presentations for other feigning measures are considered.